Pressure Ulcers

The NHS Safety Thermometer asks you to record the patient’s WORST old pressure ulcer and WORST new pressure ulcer. An ‘old’ pressure ulcer is defined as being a pressure ulcer that was present when the patient came under your care, or developed within 72 hours of admission to your organisation. A ‘new’ pressure ulcer is defined as being a pressure ulcer that developed 72 hours or more after the patient was admitted to your organisation.

 

In each of the ‘old’ and ‘new’ pressure ulcer columns, record the category of the WORST pressure ulcer the patient has, using the drop down menu provided. If the patient has no pressure ulcer, or a pressure ulcer that is deemed less severe than a category 2, chose the ‘None’ option from the drop down menu. The category is based on the European Pressure Ulcer Scale:

  • Category II – Partial Thickness Skin Loss Or Blister
    • Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured blister.
  • Category III – Full Thickness (Fat Visible)
    • Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Some slough may be present. May include undermining and tunnelling.
  • Category IV – Full Thickness Loss (Bone Visible)
    • Full thickness tissue loss with exposed bone, tendon or muscle. Slough or Eschar may be present. Often includes undermining and tunnelling.

 

This data enables the calculation of the following indicators:

  • P1:
    • The proportion of patients with an OLD pressure ulcer (present on admission to your organisation or developed within 72 hours) documented following skin inspection on the day of survey.
  • P2:
    • The proportion of patients with a NEW pressure ulcer (NOT present on admission to your organisation or developed within 72 hours) documented following skin inspection on the day of survey.
  • P3:
    • The proportion of patients with ANY pressure ulcer (new or old) documented following skin inspection on the day of survey. Where a patient has an old pressure ulcer which has got worse in your care this would be considered a new pressure ulcer. Each of these measures can be viewed by category (II-IV).

Your Queries:

Staff can only record Grades 1 to 4 , but some are classified as Ungradeable (when the wound bed can’t be viewed and the assessor is unable to clarify what the Grade will be once the wound bed is able to be viewed); therefore staff are recording these as Grade 4 when they are not . We realise that Safety Therm is national – but wonder if there are some guidelines on how these should be recorded / or how other Trusts are doing this ?

​​​There isn’t a defined national approach. Most organisations pick a grade to use for the purposes of reporting and use tag and flag to highlight for local improvement purposes. That doesn’t help for national analysis (we strip out tag and flag) but can be communicated to local commissioner for CQUIN/assurance purposes.​